High rate of health care worker injuries worries employers and insurersPosted On: Aug. 25, 2013 12:00 AM CST
Health care facilities are increasingly drawing attention for their unique exposures, which drive more worker injuries than occur in either manufacturing or construction operations.
More obese patients requiring lifting, dementia-related altercations driven by an aging patient population, and an older workforce are contributing to a disproportionate number of employee injuries and losses at hospitals and nursing homes, experts say.
In response, health care companies have ramped up risk mitigation efforts amid increasing injury costs, as well as union, regulator and insurer recognition of the problems.
Loss mitigation efforts to curb employee injuries across the health care industry are relatively new because limited risk management budgets have focused more on patient safety, said Lori Severson, health care loss control consultant for Lockton Cos. L.L.C. in Denver. Patient safety has received greater media, regulator and public survey scrutiny than workers comp losses, she said.
“So I see an imbalance between patient safety and employee safety in health care, but it's tipping stronger (toward employee injury loss reduction as employers) see that the total cost of risk is very heavy for work comp and they need to change that,” Ms. Severson said.
Studies calling for systemwide improvements, meanwhile, continue reporting a substantial number of worker injuries.
Last month, for example, a nonprofit consumer organization named Public Citizen issued a report questioning the U.S. Occupational Safety and Health Administration's ability to protect health care workers.
“In 2010, for instance, health care employers reported 653,900 workplace injuries and illnesses ... 152,000 more than the next most afflicted industry sector, manufacturing,” according to the report, citing U.S. Department of Labor data.
Neither OSHA shortcomings in overseeing health care operations, nor the industry's worker injury rates are surprising, experts say.
Barry Weiner, senior vice president and account executive for Aon Risk Solutions in Philadelphia, for example, said his advising career has spanned pulp and paper manufacturers and health care companies.
“You would think pulp and paper manufacturing would be one of the most dangerous, hard-to-fix industries you could think of,” Mr. Weiner said. “But ironically, health care is 10 times the challenge and certainly has a higher incident rate than heavy manufacturing.”
The potential dangers health care workers face include blood-borne pathogens, drug and chemical exposures, needle sticks, radioactive materials, violence, slip-and-fall accidents, and back or musculoskeletal injuries from lifting or repositioning patients.
But “the two biggest risks for hospitals and nursing homes include combative behavior, and the biggest one (overall) is the lifting risk,” said Steve Cooper, president of United Wisconsin Insurance Co., a Milwaukee-based workers compensation insurer that, as United Heartland, underwrites more than 400 hospitals and nursing homes.
Data shows that to be the case.
In 2010, nursing aides, orderlies and attendants suffered 249 incidences per 10,000 workers of musculoskeletal disorders, such as back injuries due to lifting, that required days away from work, according to U.S. Department of Labor data. In contrast, the average rate for all workers during the year was 34 per 10,000 workers, according to the Public Citizen research.
Violence, including assaults and threats of assault, also occur more frequently in health care settings.
On average throughout the past decade, health care workers have accounted for two-thirds of all U.S. nonfatal workplace violence injuries involving days away from work, prompting the National Institute for Occupational Safety and Health to announce earlier this month a free online violence prevention training course for nurses.
The losses mean many insurers decline to write health care accounts.
A high rate of costly claims drove Employers Holdings Inc. to shy away from underwriting long-term care facilities beginning about four years ago, said Steve Festa, chief claims officer for the Reno, Nev.-based workers compensation insurer.
The insurer also found providing return-to-work opportunities was problematic at long-term facilities because the workers typically are older, requiring longer recovery times, and the facilities could not provide enough modified-duty positions, Mr. Festa said.
“We are not comfortable the (long-term care) industry is where it needs to be yet,” Mr. Festa said. “But some (long-term care facility operators) are recognizing that the injuries are expensive and they need to think differently from a loss control standpoint.”
United Heartland won't bind a health care account unless their executive management team shows it is committed to safety and will work with the insurer's loss control services to make improvements, Mr. Cooper said.
Loss control measures that hospitals and nursing homes have adopted include installing patient-lifting technology and training nurses to recognize dementia patients' nonverbal cues, Ms. Severson said.
Even larger, self-insured hospitals, have faced economic challenges that have limited them to “taking infant steps” on employee safety improvements, she said.
Efforts to improve are being helped, however, by greater recognition of a link between patient safety and worker injuries, Mr. Weiner said. Fewer worker injuries mean there are more hospital employees on the job to provide care, he said.
The statistics do not yet reflect improvements, however, because the efforts are still maturing, Mr. Weiner said.
“These programs are just being understood and implemented,” he said. “We are not reaping the benefits of them yet.”